Identifying and Addressing Health Disparities in Thyroid Cancer Care.

Disparities in health care are defined as differences in health insurance coverage, access to and use of care, and quality of care between groups(1). Like disparities in other areas of health care, racial/ethnic disparities in thyroid cancer care are driven in part by structural and institutional barriers, such as limited transportation and discriminatory practices, and may be further compounded by social determinants of health like financial resources, literacy, and social status. Previous work by Shah et al (2) has shown that minorities like Black, Hispanic, and Asian patients usually present with more advanced stages of thyroid cancer and receive suboptimal treatment in terms of surgery and radioactive iodine therapy. These findings highlight the need to better understand the etiology of such disparities and identify potential interventions that improve thyroid cancer treatment within minority populations.

Identifying the key players involved in providing minority populations with thyroid cancer care is an important step in achieving equity because it can help target interventional strategies. A recent publication by Radhakrishnan et al (3) titled “Physician specialties involved in thyroid cancer management: implications for improving health care disparities” revealed that primary care providers (PCPs) are more involved in thyroid cancer care for minorities and those older than 65 years, despite a significant number of them reporting being “uncomfortable” discussing the subject. The authors also highlight how PCPs who traditionally are trusted by minority patients, and in some cases may be their only point of contact with the health care system, play a critical role in helping with access, education, and communication. These findings highlight the importance of both the messenger and the message itself when addressing some of the disparities in thyroid cancer care.

We commend the authors for an excellent work. The paper, unsurprisingly, highlights what is known with regard to minorities receiving less than optimal cancer care (4). An interesting finding, however, is that older patients were just as likely as minorities to greatly depend on their PCPs. These providers have well-established relationships and trust with their patients, are often more accessible to vulnerable and underserved patients than specialists, and are therefore well positioned to help bridge the gaps in care. To do so effectively, they need to be equipped with the necessary resources and information to help guide their patients. Such information regarding thyroid cancer is readily available through the Endocrine Society and American Thyroid Association websites. As the authors indicate, PCPs armed with these tools could then offer such educational materials to their patients and review and reinforce specialists’ recommendations.

The authors made some very helpful recommendations. However, an area that has yet to be explored is physician and provider diversity in thyroid cancer care, which may be equally important, and is a subject that demands attention from thyroid cancer specialists and medical societies. Endocrinologists and thyroid surgeons from a greater diversity of backgrounds will be needed as we strive to improve thyroid cancer care for minority patients. Lack of diverse representation within the health care workforce contributes to a variety of policies, procedures, and delivery systems that are not well suited to meet the needs of diverse patient populations. Moreover, the absence or underuse of interpreter services and linguistically appropriate educational materials can contribute to poor patient-provider communication, decreased patient compliance, and lower-quality care.

Cultural barriers contributing to racial health disparities have been identified at various levels of health care, including organizational, structural, and clinical. There is a need to provide increased cross-cultural education to providers so they may be more aware of patients’ values, beliefs, and behaviors and, ultimately, better engage with and serve diverse populations (5) The subject of cultural competency is one that demands more attention from thyroid cancer specialists and medical societies and will be vital to building effective and culturally competent interventions and improving diversity in thyroid care.

As we consider options to improve thyroid cancer health equity, we believe that eliminating barriers to health care access and improving processes within the health care systems might lead to improved outcomes. The wider use of telemedicine (telehealth and e-consults) could also help to improve access to specialty care (endocrinologist and surgeons) and provide guidance to PCPs, particularly when such care may not be readily available at the local level. As a result of the COVID-19 pandemic, advances in telemedicine have occurred much more rapidly than we could have anticipated. We should be taking advantage of virtual health care platforms to improve access and overcome structural barriers for patients from resource-poor communities. For excellent thyroid cancer surgical outcomes, efforts should be made to send patients to high-volume surgeons (6). Virtual visits may help reduce the burden of repeated office visits for patients, as initial consultations and many postoperative follow-up visits could be conducted remotely, making less-frequent travel to the surgery center more feasible (7).

Identifying the gaps in the health care disparities is a vital first step to combatting health care inequality but should not be the last. Much work remains to be done, and it is the responsibility of all of us (stakeholders) involved in the care of patients to provide our PCP colleagues and our patients the necessary support, education, and tools to achieve better outcomes and create a more inclusive health care community.